This book has a combined focus on two neurodegenerative conditions: dementia with Lewy bodies and Parkinson’s disease with dementia. While patients with either disorder experience quite variable problems, these two disorders have striking similarities when viewed in the aggregate. Thus, the symptoms of these two conditions are much the same, and so are the treatment strategies. Before addressing treatment, it is crucial to define the relevant terms, broaden our understanding, and discuss how these diagnoses are made. We will start with some basics. These disorders typically start in middle age and later, where selected brain circuits deteriorate for unknown reasons. Common neurodegenerative conditions include Parkinson’s disease, Alzheimer’s disease, and amyotrophic lateral sclerosis (ALS; Lou Gehrig’s disease). Such conditions involve limited regions of the brain or spinal cord, slowly progressing and leading to disability. Each is clinically identified by the specific neurologic deficits unique to that condition. Why each affects certain brain regions, sparing others, is a crucial but unanswered question. Although much has been learned about degenerative syndromes, we do not know the causes of any of them. Dementia implies a loss of intellectual abilities sufficient to compromise activities of daily living. Most often the term dementia is used in the context of neurodegenerative disorders. Mild thinking and memory problems that do not substantially interfere with daily routines fall into the category of mild cognitive impairment (MCI; see below). Doctors diagnosing dementia rely on the history from the patient and family, plus cognitive tests. Short tests assessing memory, attention, and calculation, among other things, can be done in the doctor’s office. Such tests include the so-called Mini-Mental State Examination and the Short Test of Mental Status. More refined and informative tests, termed psychometric testing, are done under the auspices of psychologists; these typically require 2 to 4 hours. Clinicians addressing dementia must also look for treatable causes before concluding that the problem is a neurodegenerative dementia. This assessment typically includes a brain scan, blood tests, and a review of the patient’s medical history and medication list, which may indicate the need for additional testing.
Keywords: Alzheimer's disease, Mini-Mental State Examination, Short Test of Mental Status, amyotrophic lateral sclerosis (ALS), blood-brain barrier, brain imaging, cerebrovascular disease, cholesterol elevation, diabetes mellitus, leukoaraiosis, resting tremor, ropinirole (Requip), rotigotine (Neupro)
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